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Cricopharyngeal myotomy is a surgical procedure aimed at alleviating dysphagia, which is the medical term for difficulty swallowing. This condition often arises due to spasms of the cricopharyngeal muscle, a critical sphincter muscle located at the upper esophagus. The cricopharyngeal muscle originates from the lateral borders of the cricoid cartilage and encircles the superior portion of the cervical esophagus, functioning to regulate the passage of food and liquids into the esophagus. The procedure involves a left-sided neck incision to access the cricopharyngeus muscle directly. By cutting the muscle fibers, the surgery aims to relieve the spasms that hinder swallowing, thereby improving the patient's ability to ingest food and liquids comfortably. The approach and technique used in this procedure are designed to provide optimal exposure and minimize complications, ensuring that the underlying esophageal mucosa is preserved while effectively addressing the muscle spasm.
© Copyright 2025 Coding Ahead. All rights reserved.
The cricopharyngeal myotomy is indicated for patients experiencing significant difficulty swallowing, known as dysphagia, primarily due to spasms of the cricopharyngeal muscle. This condition can lead to various complications, including aspiration, malnutrition, and dehydration, necessitating surgical intervention to restore normal swallowing function.
The cricopharyngeal myotomy procedure involves several critical steps to ensure effective treatment. Initially, a left-sided neck incision is made over the cricoid cartilage to access the cricopharyngeal muscle. This incision allows for the creation of subplatysmal skin flaps, which are elevated superiorly and inferiorly to provide a wide exposure of the cricopharyngeus. Following this, the anterior border of the sternocleidomastoid muscle is identified and reflected posteriorly, which helps to expose the carotid sheath. A careful dissection plane is then created between the carotid sheath and the laryngotracheal complex to facilitate further access. If necessary, the omohyoid muscle may be sectioned to enhance visibility and access to the surgical site. Once adequate exposure is achieved, the larynx is rotated to the right, allowing for a clear view of the cervical esophagus. The surgeon then identifies the fan-shaped band of cricopharyngeal muscle fibers. The myotomy involves cutting these muscle fibers until the underlying esophageal mucosa is visible. The incision is extended both superiorly and inferiorly to ensure that all muscle fibers are adequately severed. After completing the myotomy, the surgical site is irrigated, and a suction drain is placed to prevent fluid accumulation. Finally, the platysma muscle is reapproximated, and the skin is closed around the drain to complete the procedure.
Post-procedure care for patients who have undergone cricopharyngeal myotomy typically involves monitoring for any complications, such as infection or bleeding. Patients may be advised to follow a specific diet as they recover, gradually transitioning from liquids to soft foods as tolerated. The presence of a suction drain will be managed to ensure proper drainage and prevent fluid accumulation at the surgical site. Follow-up appointments are essential to assess healing and the effectiveness of the procedure in alleviating dysphagia. Patients should be educated on signs of potential complications and the importance of adhering to post-operative instructions for optimal recovery.
| Short Descr | CRICOPHARYNGEAL MYOTOMY | Medium Descr | CRICOPHARYNGEAL MYOTOMY | Long Descr | Cricopharyngeal myotomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 33 - Other OR therapeutic procedures on nose, mouth and pharynx |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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